Children's Headaches: Cause for Concern?

DEAR MAYO CLINIC: Once or twice each week, my 7-year-old complains that her head hurts. At what point do I need to have her see a doctor, and what could be causing headaches in such a young child?

ANSWER: Although recurrent headaches are uncommon in school-age children, they can happen. Most children who have recurrent headaches usually get them about once or twice a month. Because your daughter is having headaches more frequently, I'd recommend you make a doctor's appointment for her to be evaluated. Headaches in children usually aren't a cause for concern. Often, steps can be taken to reduce the frequency and pain of recurrent headaches in children.

If your daughter's headache pain is mild to moderate, she's likely experiencing tension headaches. If the pain is more severe, they may be migraine headaches. Approximately 10 percent of school-age children get recurrent migraine headaches.

Migraine headaches in children differ from migraine headaches in adults. Adults with migraine usually have one-sided headaches, whereas children tend to have migraine headaches on both sides of their head. Adults with migraine headaches often see lights, dots or spots (a visual aura) prior to their headaches. Children, particularly children under age 10, rarely have visual auras. Also, children tend to have headaches of much shorter duration than adults. Headaches in children typically last 30 to 60 minutes or less.

Fortunately, many children eventually outgrow recurrent migraine headaches. Research has shown that about 50 percent of children who experience migraine headaches in middle school eventually stop getting migraine attacks as they age.

Children who get migraine headaches will often have a family history of migraine and thus have a hereditary predisposition to this condition. But heredity isn't the sole cause. A variety of factors in a child's environment can increase the frequency of both tension and migraine headaches.

For example, pediatric headaches often increase when a new school year starts. The two most common reasons are lack of sleep and busy schedules. As children switch from the summer months - when they're able to sleep as long as they need to - into the fall - when they have to get up early - many don't get enough sleep. Inadequate sleep is a frequent headache trigger. Being very busy can sometimes promote headaches, as well. Additional factors such as sensitivity to certain foods, skipping meals and sensitivity to motion can also make some children prone to headaches.

When children get headaches, appropriate pain control is important. Some children do well with acetaminophen (Tylenol), but many prefer ibuprofen (Advil, Motrin) as a pain reliever. When a headache starts, give your child the correct dose of her preferred pain medication. Try to treat a severe headache as soon as possible.

For a situation such as your daughter's, where headaches occur more than once a week, you may also want to consider preventive headache therapy. Preventive therapy involves taking daily medications to help prevent headaches from occurring. Several medications are available for this purpose, and many pediatric patients who have frequent headaches benefit from preventive medicines.

Although the majority of recurrent headaches in children are not symptoms of an underlying medical disorder, several red flags could indicate a more serious problem. These include a sudden change in the severity of the headaches, difficulty moving arms or legs during a headache, headaches that wake a child from sleep, or a persistent headache that doesn't go away.

To confirm that the headaches aren't part of a larger problem, and to determine the best treatment plan to control her headaches, it's important that your daughter be evaluated by her regular physician or a neurologist. -- Kenneth Mack, M.D., Ph.D., Neurology, Mayo Clinic, Rochester, Minn.